Form Ps31202 03 PDF Details

In the realm of driver rehabilitation and safety, the Minnesota Department of Public Safety introduces a crucial instrument for ensuring that those with DUI convictions can navigate the road to redemption while ensuring public safety - the Ps31202 03 form. This form serves as the foundational agreement for participants in the Minnesota Ignition Interlock Device Program, marking the intersection of legal accountability and technological intervention in DUI prevention efforts. Through this agreement, individuals consent to the installation, maintenance, and regular calibration of an ignition interlock device in their vehicles, acknowledging its role as both a guardian and gatekeeper of their driving privileges. By dictating strict compliance with the program guidelines, including sanctions for violations such as tampering, bypassing the device, or failing to meet test requirements, the form outlines a path of rigorous oversight. Additionally, it features a waiver of liability towards the State of Minnesota, underlining the participant's acknowledgment of personal responsibility in the use of the device. Prospective participants are advised to complete and return this form, along with any necessary enrollment documents, to the designated address, ensuring a step towards reformed driving behavior under the vigilant eyes of the Ignition Interlock Device Program.

QuestionAnswer
Form NameForm Ps31202 03
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesPS31202-03, mn, retests, mn ignition interlock administrative review

Form Preview Example

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

Ignition Interlock Participation Agreement

Minnesota Ignition Interlock Device Program

This form can be faxed to (651) 797-1299. You may also bring this form to any Driver Exam Station (Visit the DVS Website for all Office Locations) or mail this form to Driver and Vehicle Services, Ignition Interlock Unit, 445 Minnesota Street, Suite 177, St. Paul, Minnesota 55101. Please retain a copy for your own records. Your application will not be complete until all enrollment documents have been received by DVS. For questions, contact DVS at (651) 296-2948 or visit http://dvs.dps.mn.gov.

________________________________________________________________________________

Driver Information

Driver’s License Number

State of Issue

_________________________________________________________________________________________________

First NameMiddle NameLast Name

_________________________________________________________________________________________________

AddressCity/State/Zip

____________________________________

________________________________

Home Telephone Number/Cell Phone

Date of Birth

Certification

I understand that I must have an ignition interlock device in each vehicle that I operate during the entire time that I am subject to an ignition interlock restriction and that the device must be calibrated and maintained in accordance with Minnesota law. The only exception to this is an approved employment variance granted by Driver and Vehicle Services.

I acknowledge that I have received, reviewed and agreed to abide by the Minnesota Ignition Interlock Device Program Guidelines.

I understand that any violation of the conditions outlined in the Program Guidelines may result in sanctions being imposed. These sanctions may include an extension of my time on the program and/or non-credit for the revocation time period spent using the ignition interlock device. Violations include:

Tampering, circumventing or bypassing the device

Operating a vehicle without the ignition interlock device

Violation of the ignition interlock limited license

Failure to provide at least 30 initial breath tests each month a month is considered a 30-day period (verification of abstinence applies to cancelled-IPS drivers only)

Three (3) skipped rolling retests within a six (6) month period

An initial start alcohol reading at or greater than .02 with no retest or a retest at or greater than .02 within 15 minutes

A rolling retest alcohol reading at or greater than .02 with no passing retest within 10 minutes

I agree that the State of Minnesota, its representatives and employees are not liable for any result of property damage and/or injury or death to persons which may arise, directly or indirectly, during the use of an ignition interlock device. I verify the information on this document is truthful and accurate. I understand that any false information provided may result in termination of my participation in the Minnesota Ignition Interlock Device Program.

_________________________________________________________________________________________________

Signature

Date

PS31202-03

REV. 06/12

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